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Biomedical subjects

K Huber

Publications and source records attributed to K Huber.

At least 127 records · Page 7Linked to original sources
PubMed1997

[Aortic coarctation--long-term follow-up in adults].

Surgical repair of coarctation of the aorta has been performed since 1945. Although surgical techniques have improved, problems such as restenosis and aneurysm at the operation site or hypertensive cardiovascular disease, still remain. To evaluate the long-term results after surgical repair of coarctation, 41 patients, 25 male and 16 female patients (mean age: 28 +/- 11 years, range 14-57 years), were studied 16 +/- 8 years after surgery (range 3-44 years). Mean age at surgery was 12 +/- 9 years (range 0.5-35 years). In 24 patients resection and end-to-end anastomosis had been performed, patch graft aortoplasty in nine patients, tube interposition graft in seven patients and one patient had undergone the subclavian flap technique. All patients were assessed by exact physical examination, the resting arm-to-leg systolic pressure gradient was measured by Doppler sonography, a bicycle exercise test and an echocardiogram were performed. Twenty-one patients reported postoperative symptoms such as dizziness (n = 12), headache (n = 3), cold legs (n = 10) and/or dyspnea (n = 8). In two patients the resting arm-to-leg pressure gradient was greater than 30 mm Hg, in two patients it was greater than 20 mm Hg. Gradient calculated by Doppler echocardiography ranged from 0 to 80 mm Hg (21 +/- 17 mm Hg) and showed poor correlation with the arm-to-leg pressure difference. The mean functional capacity was 89 +/- 18% (range 42-110%). In 18 patients exercise-induced hypertension was found, while in only eight patients arterial hypertension had already been known. To evaluate the morphology of the aorta MRI was performed in 28 patients. No aneurysm was found. In five patients a minimal lumen diameter as small as 9-11 mm was measured. Patients were divided into two groups according to their age at operation, group I: < 9 years (n = 19) and group II: > 9 years (n = 22). Resting blood pressure was significantly higher in group II (135 +/- 27 mm Hg vs 114 +/- 20 mm Hg, p < 0.009), anti-hypertensive medication (43% vs 11%, p < 0.04) and symptoms were more frequent in these patients (15/22 vs 6/19, p < 0.04). However at time of follow-up examination the age of patients of group II was significantly higher (33 +/- 12 vs 22 +/- 5 years, p < 0.0005). Between these two groups there was no difference in follow-up time and results of echocardiography or stress test. In conclusion, despite good long-term results after surgical repair of coarctation of the aorta, patients should be followed on a regular basis primarily in order to recognize systemic hypertension as early as possible and to improve the long-term outcome in these patients by antihypertensive treatment.

Adolescent↗
PubMed1997

[Pathophysiological mechanisms of the renin-angiotensin system and its pharmacologic modification by ACE inhibitors or angiotensin II (type 1) receptor blockers in cardiovascular diseases].

As a net effect of ACE-inhibitors and AT1-receptor antagonists on the renin-angiotensin system (RAS) cardioprotection due to vasodilative (reduction of blood pressure, afterload reduction), antiproliferative (reduced cell growth, reduction of "vascular" and/or "ventricular remodeling", reduced formation of extracellular matrix), as well as antiadrenergic actions and due to the stimulating effect on natriuresis, reduction of blood pressure, preload reduction can be expected. These aims of therapy have mostly been confirmed for the action of ACE-inhibitors by experimental and clinical studies but except for the treatment of arterial hypertension and few preliminary reports concerning the treatment of cardiac dysfunction, no comparable data are available for AT1-receptor antagonists. To date, an antithrombotic and profibrinolytic action could only be demonstrated for ACE-inhibitors. This effect has been discussed to be responsible for the improvement of long-term prognosis in patients with coronary artery disease. Despite the similar spectrum of action there exist important differences between ACE-inhibitors and AT1-receptor antagonists that might underline the need of an individual use of these drugs: the dual action of ACE-inhibitors on the RAS and the kinin system bears many benefits but has been also shown to be accompanied by side-effects, mainly chronic dry cough, in a relatively high percentage of patients thus leading to discontinuation of therapy in 8-14%. This respective side-effect can be prevented by the use of AT1-receptor antagonists. It has been discussed whether the incomplete action of ACE-inhibitors on AT1-receptor-mediated effects is at least in part responsible for the efficacy of this drug which is relatively high (75-80%) as compared to other substances. Due to their direct action, AT1-receptor-blockers might also be of high effectiveness for the treatment of severe heart failure. A combination of the ACE-inhibitor-mediated activation of the kinin-system with the more specific blockade of AT1-receptors by AT1-receptor antagonists might be of benefit and is currently under investigation. Finally, it has been discussed that the increased AT II concentration in case of AT1-receptor-blockade activates AT2-receptor-mediated mechanisms thus leading to an additive vasoprotective effect.

Angiotensin Receptor Antagonists↗
PubMed1997

Is oxidative stress causally linked to unstable angina pectoris? A study in 100 CAD patients and matched controls.

OBJECTIVE: Unstable angina pectoris often leads to acute myocardial infarction. Since lipid peroxidation is thought to be causally related to chronic and acute events in atherosclerosis and coronary artery disease, we measured lipid peroxidation products and vitamin E in 100 patients with coronary artery disease and compared them to a matched control group. METHODS: 50 consecutive patients with stable angina pectoris (SAP) and 50 consecutive patients with unstable angina pectoris (UAP) were studied and compared to 100 clinically healthy individuals. In addition to conventional lipid and lipoprotein analysis, malondialdehydes were measured as thiobarbituric acid reactive substances (TBARS). Lipid hydroperoxides were assayed with the colorimetric methylene blue method. alpha-Tocopherol was quantitated by HPLC after extraction of serum with hexane-ethanol. In the patient group conjugated dienes were also measured. RESULTS: As expected, patients had significantly higher cholesterol, triglyceride LDL-C and Lp(a) values and lower HDL-C values than controls. When patients were divided into groups with SAP and UAP respectively, peroxides and TBARS were significantly higher in the latter group as compared to patients with SAP and to controls. Conjugated dienes were also significantly higher in patients with UAP as compared to patients with SAP. Total plasma alpha-tocopherol was comparable in all three groups, whereas the alpha-tocopherol content per LDL particle was lowest in patients with UAP, followed by patients with SAP and then controls. CONCLUSION: It is concluded that lipid peroxidation parameters are increased in patients with UAP and discriminate SAP from UAP patients.

Aged↗
PubMed1997

Comparison of EDTA and acid-citrate-dextrose collection tubes for detection of cytomegalovirus antigenemia and infectivity in leukocytes before and after storage.

Duplicate blood samples collected in EDTA and acid-citrate-dextrose (ACD) were compared by cytomegalovirus (CMV) pp65 antigenemia and CMV infectivity on the day of sample collection and after 1 and 2 days of storage at 4 degrees C. No significant difference was detected between EDTA and ACD. However, CMV antigenemia was more sensitive than culture at all time points tested.

Blood Preservation↗
PubMed1997

Antifibrinolytic properties of the vascular wall. Dependence on the history of smooth muscle cell doublings in vitro and in vivo.

Increased expression of plasminogen activator inhibitor-1 (PAI-1) mRNA in atherosclerotic human arteries suggests a linkage between PAI-1 gene expression and cellular proliferation, the fundamental feature of atherosclerosis. To investigate whether smooth muscle cell (SMC) proliferation influences overall fibrinolytic properties of the vascular wall, we examined the effect of serial in vitro passaging of human SMCs on tissue plasminogen activator (TPA) and PAI-1 synthesis levels as well as the ability to modulate TPA and PAI-1 synthesis of human umbilical vein endothelial cells (HUVECs). As in vivo correlates for such late-passage cells in culture, SMCs derived from human atherosclerotic plaques were used, because they are thought to have already undergone numerous cell doublings. We observed an increase of PAI-1 secretion (from 591 +/- 106 to 2952 +/- 290 ng PAI-1.10(5) cells-1.24 h-1) with a concomitant fourfold to fivefold increase of PAI-1 mRNA levels, as well as a decrease of TPA secretion (from 118 +/- 34 to 8 +/- 1.3 ng TPA.10(5) cells-1.24 h-1) and a twofold to threefold decrease of TPA mRNA levels with increasing in vitro passage number (from passage 3 to 11) of normal pulmonary artery smooth muscle cells (PASMCs) (P < .05). SMCs derived from atherosclerotic plaques of coronary arteries (CASMCs) displayed higher levels of PAI-1 antigen synthesis (3093 +/- 507 ng PAI-1.10(5) cells-1.24 h-1) with an approximately twofold increase of PAI-1 mRNA levels, as well as decreased levels of TPA antigen synthesis (10 +/- 1.6 ng TPA.10(5) cells-1.24 h-1) with an approximately 1.5- to 2-fold decrease of TPA mRNA levels in passage 1, compared with their counterparts derived from normal-appearing arterial tissue of the same vessel (1794 +/- 525 ng PAI-1.10(5) cells-1.24 h-1; 17 +/- 5 ng TPA.10(5) cells-1.24 h-1) (P < .001; P < .01). Incubation of HUVEC cultures with the 24-hour conditioned media (CM) of early-passage PASMCs decreased endothelial PAI-1 antigen synthesis by approximately 42% (P < .001) and endothelial PAI-1 mRNA levels about twofold to threefold (P < .001), whereas by incubation with the 24-hour CM of late-passage PASMCs, endothelial PAI-1 antigen synthesis was upregulated by 68% (P = .001), with a concomitant twofold increase of endothelial PAI-1 mRNA levels (P < .001). The apparent MW of this heat- and acid-stable PAI-1 upregulating factor appears to be between 50 and 100 kD, as judged by ultrafiltration. Incubation of HUVEC cultures with the 24-hour CM of early-passage CASMCs derived from normal-appearing arterial tissue showed no significant influence on endothelial PAI-1 synthesis, whereas incubation with late-passage normal CASMCs, as well as early-passage atherosclerotic CASMCs from the same vessel, increased endothelial PAI-1 antigen secretion by 45% and 48% (P < .001), with a concomitant 1.5 fold to 2-fold increase of endothelial PAI-1 mRNA levels (P < .05). No significant change in endothelial TPA synthesis was observed by incubation with CM of either PASMCs (early or late passage) or CASMCs (atherosclerotic or normal). These data suggest that SMC proliferation is associated with (1) increased SMC PAI-1 synthesis as well as decreased TPA synthesis and (2) upregulation of endothelial PAI-1 synthesis by SMC CM. This phenomenon is observed with either late passages of normal PASMCs and CASMCs or early passages of atherosclerotic plaque CASMCs. This suggests that proliferating SMCs are a major regulator of the fibrinolytic potential within the vessel wall, thereby contributing to the thrombotic risk associated with the development of atherosclerosis.

Arteriosclerosis↗
PubMed1997

The effect of anticoagulant therapy in primary and anorectic drug-induced pulmonary hypertension.

In a retrospective study, we tested the hypothesis that anticoagulant therapy with warfarin sodium (Coumadin) has a beneficial influence on the long-term prognosis in patients with primary pulmonary hypertension (PPH) and aminorex-induced plexogenic pulmonary hypertension. The study included a total of 173 patients from two European cities. One hundred four of these patients took the anorectic drug aminorex (Menocil), which was available in some European countries almost 30 years ago; 69 patients had pulmonary hypertension of unexplained etiology, ie, PPH. Fifty-six of the 104 aminorex-treated patients and 24 patients in the PPH group received warfarin after diagnosis was established. For analysis, patients were divided into four groups according to their history of aminorex intake and anticoagulant therapy. Survival time, changes in hemodynamics (pulmonary arterial pressure), and improvement in quality of life (scored by the New York Heart Association [NYHA] classification) were compared and analyzed. We found that aminorex-treated patients had a better long-term prognosis than those with PPH (7.5 vs 3.9 years; p < or = 0.001). The best mean survival time of 8.3 years was found in anticoagulated aminorex-treated patients, compared to 6.1 years in nonanticoagulated aminorex-treated patients. Moreover, aminorex-treated patients who received anticoagulant therapy soon after the onset of symptoms showed significantly better prognosis (10.9 years) than those who commenced treatment 2 years thereafter (5.9 years) (p < or = 0.05). In patients with PPH, systolic pulmonary pressure was shown to influence survival time significantly (p < or = 0.0005); however, this correlation was not found in aminorex-treated patients. An improvement of symptoms like dyspnea on exertion was seen in 44.8% of the anticoagulated aminorex-treated patients, while deterioration was evident in 72.2% of the nonanticoagulated aminorex-treated patients. In conclusion, our study has shown that anticoagulant therapy had a positive influence on long-term survival and a significant improvement in quality of life in patients with PPH, in particular in patients with a history of anorectic drug intake.

Adolescent↗
PubMed1997

Evaluation of soluble CD44 splice variant v5 in the diagnosis and follow-up in breast cancer patients.

Aberrant expression of CD44 splice variants has been detected on a variety of human tumor cells. Overexpression of specific isoforms has been shown to be associated with metastasis and poor prognosis in breast cancer. We evaluated the possible utility of soluble CD44 splice variant v5 (sCD44v5) as a circulating, tumor-associated marker in breast cancer patients. Serum levels of sCD44v5 were determined in 147 healthy volunteers, in 53 patients with nonmalignant breast disease, in 85 patients with breast cancer at presentation, in 13 patients with recurrence and in 73 patients with active metastatic disease. Statistically, the levels at presentation in stages I-IV, in benign disease, and in a female control group were not significantly different. First longitudinal studies over 1-2 years in the follow-up of 28 patients who have remained tumor-free showed considerable between-patient variation while the intrapatient levels remained within relatively narrow limits. In patients with active metastatic disease, elevated levels of sCD44v5 (> 58 ng.ml-1) were detected in 50% of the cases with marked elevation in only 26%. In these cases, sCD44v5 correlated with the extent of metastatic disease and fell during clinical response to cytoreductive therapy. In comparison with CA15-3 in the patients' follow-up serum levels of sCD44v5 proved to be much less sensitive concerning lead time, percentage of raised serum levels at the time of recurrence and in metastatic disease. The value of sCD44v5 determinations in breast cancer patients was further limited by the poor diagnostic specificity of this marker due to elevated levels in smokers and chronic inflammatory disease.

Alternative Splicing↗
PubMed1996

Effects of antihypertensive therapy on glucose and lipid metabolism.

Large epidemiological studies demonstrate only moderate reduction in the incidence of coronary artery disease by antihypertensive drug treatment. This is attributed to the prevalence of multiple risk factors in hypertensive patients and to possible adverse metabolic effects of antihypertensive drugs which may counteract their ability to reduce the risk of cardiovascular disease. The choices for pharmacological blood pressure reduction are divided between five classes with similar antihypertensive efficacy but markedly different influence on coronary risk factors. Hence, the clinician has to consider the prevalence of coexisting coronary risk factors, comorbidity as well as the efficacy, side effects, and mechanisms of drug action.

Antihypertensive Agents↗
PubMed1996

The ACE-inhibitor lisinopril affects plasma insulin levels but not fibrinolytic parameters.

There is evidence that ACE-inhibitors exert beneficial effects on endogenous fibrinolysis in patients with previous myocardial infarction. It is still unknown if this effect is restricted to this patient group only and by which mechanisms ACE-inhibitors exhibit the profibrinolytic effects. One possible explanation might be the positive influence of ACE-inhibitors on insulin metabolism by decreasing plasma insulin which in turn could decrease PAI-1, a major regulator of the fibrinolytic system. Therefore the present study examines the relationship between insulin and PAI-1 plasma levels during intravenous glucose tolerance tests before and after administration with the ACE-inhibitor lisinopril in 12 male obese patients with angiographically proven coronary artery disease and borderline hypertension. After a 4-weeks wash-out period glucose tolerance tests were performed before and after lisinopril-treatment (10mgs/d) for 12 weeks. After the treatment period, fasting plasma insulin level decreased from 15.6 +/- 2.1 to 11 +/- 1.8 uU/ml, p < or = 0.01. Stimulated levels of insulin during glucose tolerance test also significantly decreased by lisinopril (peak insulin from 57 +/- 10 to 41.2 +/- 7.3 uU/ml, p < or = 0.02). Basal plasma tissue plasminogen activator antigen, PAI-1 total antigen and PAI-1 "active" antigen were unaffected by therapy (8.4 +/- 0.5 vs 8.6 +/- 0.5 ng/ml, 118 +/- 20 vs 124 +/- 16 ng/ml and 21 +/- 7 vs 30 +/- 7 ng/ml, respectively). Our data confirm a beneficial effect of lisinopril on plasma levels of insulin but failed to demonstrate any profibrinolytic effect in this study population, thus questioning the postulated mechanism of influencing endogenous fibrinolysis by changes of plasma insulin.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1996

Placental isoferritin in pregnancies with small-for-gestational age fetuses.

The secretion of placental isoferritin (PLF) during pregnancy could be responsible for the diminished immunoreaction of maternal lymphocytes against the embryo. In this study, serum levels of PLF in 335 pregnant women were correlated with birth weight, percentile of birth weight, gestational age, and pulsatility index of the uterine artery, as well as with diastolic notching. Women with small-for-gestational age (SGA) infants (birth weight below or equal to the tenth percentile) showed significantly lower PLF levels (11.7 U/ml) compared with women whose newborns were of normal weight (19.4 U/ml) (P < 0.05). In line with this finding, a strong correlation was observed between PLF levels and the percentile of birth weight, pulsatility index of the uterine artery, and the presence of diastolic notching. The strong correlation of low PLF values and SGA newborns suggests that determination of PLF could serve as a marker to identify women at risk of having such babies.

Adolescent↗
PubMed1996

Development of a rapid means of estimating the haemoglobin F content of candidate fetal cells isolated from maternal blood using HPLC.

Prenatal diagnosis of genetic disorders in nucleated fetal red blood cells present in maternal blood requires methods to detect and enrich for such cells. Here we describe a rapid high performance liquid chromatography (HPLC) method that allows one to determine as few as 100 cells containing haemoglobin F (HbF) in the presence of a vast excess of haemoglobin A (HbA)-producing cells. The HPLC separations of haemoglobins were performed with a weak cation exchange column-silica gel-bound asparaginic acid-and ammonium phosphate buffer as the mobile phase. Separations were carried out in 7 min. When applied to estimation of the recovery of fetal cells from maternal blood, the HPLC method indicates in a timely manner whether or not to proceed with further techniques (i.e., FISH or PCR). Several current techniques such as Ficoll gradients and fluorescence (FACS) or magnetic (MACS) activated cell sorting were thus evaluated. Unexpectedly, our method indicates high cell losses with both single gradient and triple density Ficoll pre-enrichment methods. Less than 20 per cent of the nucleated red blood cells can be recovered in the most optimal setting. Lysis of erythrocytes may be an alternative technique that leaves nucleated red blood cells of all maturation stages intact. Thus, any further improvements in the technology for fetal cell recovery may be aided by monitoring the yield with HPLC.

Cell Separation↗
PubMed1996

Assessment of left ventricular function: comparison between radionuclide angiography and semiquantitative two-dimensional echocardiographic analysis.

Measurement of global left ventricular function is important in the follow-up of cardiac patients and is a good prognostic indicator in acute cardiac situations. We compared quantitative measurements of global left ventricular function made with radionuclide angiography (RNA) and contrast cardiac ventriculography (CVG) to visual semiquantitative estimates from two-dimensional echocardiographic images (2D-echo). Three hundred and thirty-nine consecutive patients who underwent RNA were assessed with 2D-echo within 3 months. In addition, 92 of these patients also underwent CVG (correlation of ejection fraction between CVG and RNA: r=0.82; P<0.0001). The RNA mean ejection fractions in the four 2D-echo groups (0=normal, 1=slightly, 2=moderate, or 3=severe reduced left ventricular function) differed markedly (P<0.0001); however, there was overlapping among the groups (2D-echo score/RNA ejection fraction: 0=57.3%+/-12.8%; 1=46.0%+/-12.9%; 2=29.6%+/- 12.2%; and 3=24.6%+/-11. 5%) and the difference between 2D-echo scores 2 and 3 was not significant. 2D-echo showed a good concordance in RNA classes (0=>/=505; 1=35%-49%; 2=21%-34%; and 3=</=20% ejection fraction) 0 (133/166; 80%) and 3 (18/30; 60%) but low concordance in classes 1 (27/82; 33%) and 2 (21/61; 34%). For accurate assessment of global left ventricular ejection fraction, visual semiquantitative judgement of a 2D echocardiographic image is limited in comparison to CVG or RNA, especially in patients with a slight or moderate reduction in left ventricular ejection fraction.

Cardiac Catheterization↗
PubMed1996

Thrombolytic therapy in acute myocardial infarction.

Despite major advances made over the last decade, mortality following acute myocardial infarction (MI) is still high even for patients treated with the "front-loaded" recombinant tissue-type plasminogen activator (rt-PA) regimen: 30-day mortality is 6.3%, and it is associated with fatal cerebral hemorrhage in 1.5%. Further improvement of short- and long-term prognosis can be achieved if infusion of the thrombolytic agent starts early, if reperfusion occurs more rapidly, and if a persistent thrombolysis in myocardial infarction (TIMI) grade 3 flow of the infarct-related artery can be achieved. These prerequisites for optimal preservation of ventricular function and predictors of a favorable outcome. New treatment strategies, e.g., more accelerated dosage regimens of established thrombolytic agents, new combination therapies, and new thrombolytic agents, with or without addition of more specific and more potent new antithrombotic agents, may further improve the efficacy of thrombolysis in acute MI during the late 1990s.

Clinical Trials as Topic↗
PubMed1996

Urinary excretion of apo(a) fragments. Role in apo(a) catabolism.

The biosynthesis and assembly of lipoprotein(a) [Lp(a)], a marker for atherosclerotic disease, appears to be well understood. However, information is lacking concerning the mode and site of Lp(a) catabolism. Apo(a) is reported to be excreted into the urine. To study the effect of this pathway on the overall catabolism of Lp(a), urinary apo(a) was characterized by immunoblotting. More than 10 distinct apo(a) bands with molecular masses between 30 and 160 kD were observed. Apo(a) fragments were not complexed to apoB. In more than 30 individuals the size of apo(a) bands was comparable irrespective of their apo(a) phenotype, although marked differences in the relative intensities of the bands were observed. Eight batches of 24-hour urine collections collected from one proband at 2-week intervals exhibited a significant correlation between creatinine and apo(a) concentrations as measured by DELFIA (r = .93; P < .01). In 193 healthy volunteers a highly significant correlation was found between urinary apo(a) concentrations normalized to creatinine levels and plasma Lp(a) values (p = 0.659; P < .0001). Of the total plasma apo(a), 0.073%, i.e., 121 micrograms apo(a), was excreted in the form of apo(a) fragments in 24-hour urine samples from 12 healthy volunteers. We conclude that the catabolism of Lp(a) via excretion of apo(a) fragments accounts for < 1% of the daily Lp(a) catabolism.

Adult↗
PubMed1996

New approaches in plasminogen activator therapy.

Large efforts have been undertaken to develop more effective and safer thrombolytic agents than those currently used in clinical practice. In addition, the value of adjunctive agents influencing thrombotic and thrombolytic processes could be shown and newer agents are under active investigation. This review focuses on theoretical and practical aspects of optimizing thrombolytic therapy and mainly on genetically engineered, third generation plasminogen activators. Optimized thrombolytic therapy may make this form of therapy available to patients that are currently considered ineligible and it may lead to earlier, more complete reperfusion of infarct related coronary arteries. The benefits and risks of optimized thrombolytic regimens relative to mechanical reperfusion strategies will have to be constantly reassessed as both forms of treatment develop.

Fibrinolytic Agents↗
PubMed1996

Thrombolytic agents--an overview.

Thrombolysis today has become a routine option not only in the treatment of acute myocardial infarction but also in many other manifestations of thromboembolic disease. Until one decade ago, only two plasminogen activators, streptokinase and urokinase, were available for clinical use. They were characterized by limited thrombolytic potencies and major side effects including systemic fibrinogen breakdown, bleeds and stroke. This has prompted the search for new plasminogen activators with better pharmacological and clinical profiles. The first such new plasminogen activators were Anistreplase, a chemically modified version of the streptokinase-plasminogen-activator-complex and tissue-type plasminogen-activator produced by recombinant technology. Both new substances have fueled the development in modern thrombolytic treatment. While the clinical progress with t-PA was confirmed in large, double-blind, randomized, multicenter trials, no real superiority of anistreplase over the traditional plasminogen activators urokinase and streptokinase has been substantiated. While the clinical use of t-PA today has been established for acute myocardial infarction, pulmonary embolism and deep vein thrombosis, current research is focused on further plasminogen activators with further improved thrombolytic properties. This review summarizes the current knowledge on the biochemical and pharmacological properties of the first, second and future generation of plasminogen activators.

Fibrinolytic Agents↗
PubMed1996

Thrombolytic therapy in acute myocardial infarction--update 1996.

Despite the major advances made over the last decade, mortality following acute MI is still high for patients even if treated with the so far most effective "front-loaded" rt-PA regimen: 30-day-mortality is 6.3% and is associated with fatal cerebral haemorrhage in 1.5%. Further improvement of short- and long-term prognosis can be achieved if infusion of the thrombolytic agent starts early, if reperfusion occurs more rapidly and if a persistent TIMI grade 3 flow of the infarct-related artery can be achieved. These are prerequisites for optimal preservation of ventricular function and predictors of a favourable outcome.

Acute Disease↗